Does fish oil cause blood thinning?

Omega-3 fatty acids from fish oil have the capacity to "thin the blood." In reality, omega-3s exert a mild platelet-blocking effect (platelet activation and "clumping" are part of clot formation), while also inhibiting arachidonic acid formation and thromboxane.

But can fish oil cause excessive bleeding?

This question comes up frequently in the office, particularly when my colleagues see the doses of fish oil we use for cardiovascular protection. "Why so much fish oil? That's too much blood thinning!"

The most recent addition to the conversation comes from a Philadelphia experience reported in the American Journal of Cardiology:

Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel--versus--aspirin + clopidogrel in patients with cardiovascular disease.(Watson et al; Am J Cardiol 2009 Oct 15;104(8):1052-4).

All 364 subjects in the study took aspirin and Plavix (a platelet-inhibiting drug), mostly for coronary disease. Mean dose aspirin = 161 mg/day; mean dose Plavix = 75 mg/day. 182 of the subjects were also taking fish oil, mean dose 3000 mg with unspecified omega-3 content.

During nearly 3 years of observation, there was no excess of bleeding events in the group taking fish oil. (In fact, the group not taking fish oil had more bleeding events, though the difference fell short of achieving statistical significance.) Thus, 3000 mg per day of fish oil appeared to exert no observable increase in risk for bleeding. This is consistent with several other studies, including that including Coumadin (warfarin), with no increased bleeding risk when fish oil is added.

Rather than causing blood thinning, I prefer to think that omega-3 fatty acids from fish oil restore protection from abnormal clotting. Taking omega-3 fatty acids from fish oil simply restores a normal level of omega-3 fatty acids in the blood sufficient to strike a healthy balance between blood "thinning" and healthy blood clotting.

Comments (20) -

  • Marc

    10/26/2009 9:46:32 PM |

    Long time reader, first comment.
    Thank you for so freely sharing all the information.


  • Daniel

    10/26/2009 11:02:46 PM |

    Thank you for this!  I have had this question for a long time given the number of things I take that "thin the blood."

  • Kevin

    10/26/2009 11:44:45 PM |

    As a veterinarian I've dispensed fish oil capsules for several years.  Some owners give so many that the dogs smell 'fishy' when seen for routine care.  The owner doesn't smell it since they're with the dog a lot.  The coats are gorgeous, something that doesn't often happen in Wyoming at 7000ft altitude.

  • Dr. William Davis

    10/26/2009 11:47:45 PM |

    Hi, Kevin--

    My two Boston terriers jump for their fish oil capsules, two every day!

    I'm glad to hear from a veterinarian that the coat sheen is indeed from the fish oil.

  • Rich

    10/27/2009 1:27:09 AM |

    Due to an afib episode a couple of years ago, I was taking 20 mg of warfarin per day, plus around 5000 mg of EPA+DHA, and never had bleeding issues.  

    My INR was always a stable 2.0.

    As I've not had an afib reoccurrence, I've replaced the 20mg coumadin with 325mg aspirin daily, and still take around 5000 mg EPA+DHA.  No bleeding issues with that combo either.

  • Catherine

    10/27/2009 3:55:32 AM |

    Glad this topic came up.
    Over the last 5 years, I've had to periodically eliminate my fish oil intake as I would start to bruise badly. My internist said she has seen this occasionally with fish oil and called it "capillary fragility." I bruise easily anyway, but it would really get bad with fish oil. So there must be some quality in fish oil that influences this.

    Then about 6 months ago I started a strong supplement change to help with my low bone density--already taking magnesium and calcium but added:
    Boron, K2, silica,pomegrantate juice, and BIG increase in vitamin D.
    I also increased omegas to 3,000 a day which I was not able to tolerate before.

    It has been over 4 months since I have had ANY bruise---which is just unheard of for me. I usually have 3-4 different bruises on arms/legs. So something in these supplements  strengthened my capillaries I guess, and I can now take high fish oil doses!
    Anyone else had a bruising problem with fish oil?

  • Dr. William Davis

    10/27/2009 11:04:59 AM |

    Hi, Catherine--

    Fascinating observation!

    I'll bet it has something to do with the vitamin D, more than anything else. Vitamin D seems to strengthen structural tissues in bones, muscle, heart valves, and perhaps capillaries and other small blood vessels.

  • trix

    10/27/2009 11:59:37 AM |

    Several years ago I bruised easily for a while and attributed it to taking garlic supplements daily.  I started taking Vit C and the bruising stopped.  I don't think it had to do with fish oil (in my case); I don't think I was taking fish oil at the time.

  • Daniel

    10/27/2009 9:37:33 PM |

    I too achieve rapid blood thinning when taking 2400mg of EPA/DHA per day. That's only 4 pharmaceutical grade capsules. Even after my vitamin d levels were normalized I still got bruising.

    I now take Vitamin K2 (MK-7 natto extract) twice a week and it's allowed me to bump my EPA/DHA up to 3600mg with no ill effects or bruising.

    It was either supplement or eat a lot of aged cheese, they both seemed to do the trick in my particular case.

  • Healthy Oil Guy

    10/27/2009 9:53:51 PM |

    Thank you for sharing this study with us.  It helps clarify whether there is a risk for blood thinning from taking fish oils.  This information may help individuals who are taking blood thinning medications and considering adding fish oils to their daily diet.

  • Dave

    10/28/2009 2:22:01 AM |


    Without a doubt, your cessation of bruising was due to vitamin k2. I routinely take nattokinase, large doses of fish oil, curcumin, and other blood thinning agents, and if I don't take vitamin K2, I will begin bruising. (I also take high doses of Vitamin D). When I take K2, I have absolutely no bruising.

    Vitamin K2 has many clinical trials showing that it helps endothelium  integrity and elasticity.

    Also, grapeseed extract and pine bark extract (specifically oligomeric proanthcyanins) has the same beneficial effect.

  • Catherine

    10/28/2009 4:41:41 PM |


    That's really interesting! There is a lot of research on K2's effect on strengthening weak bones. Bone fractures go down considerably when high doses of K2 are used (Japan is using K2 as osteoporosis treatment) BUT studies show it needs to be in conjunction with adequate calcium and Vitamin D---they work synergistically for bone strength.  So it makes sense that K2 and D could do the same with strengthening fragile capillaries. I am also taking the M7 natto form.

  • Catherine

    10/29/2009 12:01:36 AM |


    Thanks for sharing your experience with this, you've really confirmed it now for me.  I can't believe I have suffered with this for most of my life with no answers (tried high dose Vit C, grape seed, etc) and now within months on K2, there's no bruising and I can tolerate fish oil. Hope my bones are responding this well!
    This blog is so helpful....

  • Mina

    10/29/2009 12:21:31 PM |

    Thanks for posting this. The question recently came up in our office. I like your assertion that omega-3s restore the blood to normal and remove abnormal clotting. And to comment on a post above, our dog has a beautifully shiny coat and takes 2 pure EPA capsules each day!

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    1/26/2010 3:40:08 PM |

    I have enjoyed reading That During nearly 3 years of observation, there was no excess of bleeding events in the group taking fish oil. (In fact, the group not taking fish oil had more bleeding events, though the difference fell short of achieving statistical significance.

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  • moseley2010

    12/7/2010 2:37:16 AM |

    I haven't heard of this problem
    fish oil supplements. But now we know what to tell them when this sort of concern comes up. Fish oil or Omega-3 is really beneficial to health. It's just important that it comes from clean waters.

  • Jack

    3/12/2013 7:03:38 PM |

    What is an appropriate dose of fish oil for someone taking coumadin?

  • dorange

    6/15/2014 3:53:03 PM |

    Dr. Davis, when  person is taking Tamoxifen...
    (1) is it safe to take vitamin k2 or K1?
    (2) will fish oil have a role in preventing blood clots?

Do statin drugs reduce lipoprotein(a)?

Do statin drugs reduce lipoprotein(a)?

Alex had lipoprotein(a), Lp(a), at a high level. With a heart scan score of 541 at age 53, treatment of this pattern would be crucial to his success.

Part of Alex's treatment program was niacin. However, Alex complained about the niacin "flush" to his primary care physician. So, his doctor told him to stop the niacin and replace it with a statin drug (Vytorin in this case).

Is this a satisfactory replacement? Do statin drugs reduce Lp(a)?

No, they do not. In fact, that's how I often meet people who have Lp(a): Their doctor will prescribe a statin drug for a high LDL cholesterol that results in a poor response. The patient will be told that statin drugs don't work for them. In reality, they have Lp(a) concealed in the LDL that makes the LDL resistant to treatment.

Lp(a) responds to a limited number of treatments, like niacin, testosterone, estrogen, and DHEA. But not to statin drugs.

Now, statin drugs may still pose a benefit through LDL reduction. But they do virtually nothing for the Lp(a) itself. Unfortunately, most practicing physicians rarely go any farther than Lipitor, Zocor, Vytorin, and the like.

If your doctor tries to shove a statin drug on you as a treatment for Lp(a), put up a fight. Voice your objections that statins do not reduce Lp(a).

Comments (17) -

  • Rich

    8/25/2007 1:19:00 AM |

    As an Lp(a)-er, I'm very interested in Dr. Davis's guidance on this topic.

    Here's a question to which there may be no answer right now:

    The makers of Krill Oil have published a paper in a c-level journal claiming spectacular improvements in LDL and HDL.
    If this is true, I wonder if Lp(a) might be improved by this stuff?

  • Dr. Davis

    8/25/2007 2:54:00 AM |

    Hi, Rich--

    Yes, you are right: there's simply insufficient information.

    I do hope that krill oil provides benefits above and beyond fish oil, but we need to develop an experience with it first.

  • aspTrader

    8/28/2007 9:03:00 PM |

    Thanks for this blog.

    High LP(a) levels run in my family although I don't have a problem with it.  I have a brother who has had a chronically high LP(a) number (between 70 and 90) for a number of years and had a mild heart attack 10 years ago at age 42 and a triple by-pass (no heart attack) 5 years ago.

    He is now doing 80mg Lipitor and 10mg Zetia and tabs of pomegranate extracts and his LDL is now at 85.  (I guess one partial treatment is to get LDL as low as possible.)

    I do a google search for LP(a) treatments every few months and, of course, there isn't anything appearing to be proven to get the LP(a) number into the normal range.

    For a while now, I've read online about massive doses of C, Lysine, etc. discussed at sites like that shown at the following link.

    This is essentially what I understand to be the Pauling/Rath treament recommendation for LP(a) treatment.  A good deal of the discussion at the site and at Rath's site is informative and convincing.

    However, it's difficult to understand why this treatment hasn't been studied in a scientific study (or maybe I'm mistaken and it has).

    What do you think about it?


  • Dr. Davis

    8/28/2007 9:15:00 PM |

    The Rath-Pauling approach has not worked in our limited experience. We've not witnessed any substantial drop in lipoprotein(a).

    However, I would stress that, despite the difficulties presented by lipoprotein(a), it can be a very controllable genetic pattern. In fact, our current record holder for plaque regression (63% drop in heart scan score) has this pattern.

    I invite you to read the full conversation about the methods we use on the Track Your Plaque website.

  • Anonymous

    8/29/2007 3:30:00 AM |

    Thanks for your comments.

    Regarding the Heart Scan Test...  I have read that a person who has had stents implanted or a bypass cannot take the test.

    Is there some other means for establishing a baseline score for existing plaque?

    Thanks again.

  • Dr. Davis

    8/29/2007 12:29:00 PM |

    Carotid ultrasound is a crude second choice as an index of bodywide atherosclerosis. It is a relatively non-quantitative test that correlates only about 60-70% with coronary disease, but that is the only other truly practical gauge. If you've had only one artery stented, however, a CT heart scan can still be performed and yield useful information.

  • Mid Life Male in CA

    8/29/2007 1:17:00 PM |

    Dr. Davis,

    Every year or so for the last 10 years, I have spent a couple of days googling and browsing the 'net to try to figure out the latest and greatest heart related therapies for myself and my family.  (High LP(a) being a significant issue.)

    Since the last time I did this, you came online with this blog and through it I discovered TrackYourPlague.

    I would just like to say Thank You for sharing your insight online.  Given my history, it has struck me that my understanding of effective therapies were different and sometimes even on a par with the medical professionals I was seeing.  In fact, the head of the patient cholesterol support center at the large HMO--you'd recognize the name if I mentioned the name--I belong to once even told me that I knew more about these therapies than she did.

    A few years ago, in speaking with my cardiologist, I mentioned some of the scientific abstracts I had read for myself about possible new high LP(a) treatments and he told me that I appeared to know more than he did about them.

    Scary !

    You likely are clear about this, but I'd like to tell you again how much the kind of information you provide is incredibly helpful.

    Your work can be literally life saving for people in need who take the time to address their heart related issues in a serious way!

    Thank you.

  • Dr. Davis

    8/29/2007 2:04:00 PM |

    Thanks, kindly, Midlife Male!

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  • Alex L

    10/4/2011 1:00:19 AM |

    I had a quadruple bypass 2 years ago. I've followed the Pauling/Rath protocol for 6 months with 12 grams ascorbic, 6 grams lysine and 3 grams proline daily. However, I just had blood lab work done and was concerened that my Lp(a) score was 275. I thought that the ascorbic/lysine combination targeted Lp(a). This issue is critical to me because vein graft patency from bypass is a function of Lp(a) levels. Any suggestions on how I can lower Lp(a) and any opinion as to why my Lp(a) score would be so high even after 6 months on ascorbic & lysine?

  • Dr. William Davis

    10/4/2011 2:37:44 AM |

    Hi, Alex--

    Sadly, I have yet to see any effect from this Pauling/Rath protocol.

    In the Track Your Plaque program, our preferred starting regimen is high-dose fish oil, i.e., 6000 mg EPA + DHA per day, but it requires up to 2-3 years to work. There are several other strategies worth considering, all discussed on the site.

  • Alex L

    10/7/2011 1:12:03 AM |

    Dr. Davis,

    I've looked all over the trackyourplaque website, but I can't find what specific advice you are referring to to reduce Lp(a). Can you please be more specific, or furnish the link? I appreciate any advice you might have. Thanks!

  • Dee

    10/7/2011 10:49:50 PM |

    I tried the Pauling/Rath protacol for six months and my LP{a} was much worse.  I take niacin and fish oil.


  • Dr. William Davis

    10/7/2011 11:01:05 PM |

    Hi, Dee--

    I, too, have yet to see any affect from this protocol.

    Perhaps it's telling that Mathias Rath is currently trying to persuade South Africans that the AIDS epidemic there is the invention of the western world.

  • Dr. William Davis

    10/8/2011 2:22:10 AM |

    Hi, Alex--

    It's all in the Library. There are several detailed Special Reports devoted to Lp(a).

Vitamin D: Deficiency vs optimum level

Vitamin D: Deficiency vs optimum level

Dr. James Dowd of the Vitamin D Cure posted his insightful comments regarding the Institute of Medicine's inane evaluation of vitamin D.

Dr. Dowd hits a bullseye with this remark:

The IOM is focusing on deficiency when it should be focusing on optimal health values for vitamin D. The scientific community continues to argue about the lower limit of normal when we now have definitive pathologic data showing that an optimal vitamin D level is at or above 30 ng/mL. Moreover, if no credible toxicity has been reported for vitamin D levels below 200 ng/mL, why are we obsessing over whether our vitamin D level should be 20 ng/mL or 30 ng/mL?

Yes, indeed. Have no doubts: Vitamin D deficiency is among the greatest public health problems of our age; correction of vitamin D (using the human form of vitamin D, i.e., D3 or cholecalciferol, not the invertebrate or plant form, D2 or ergocalciferol) is among the most powerful health solutions.

I have seen everything from relief from winter "blues," to reversal of arthritis, to stopping the progression of aortic valve disease, to partial reversal of dementia by achieving 25-hydroxy vitamin D levels of 50 ng/ml or greater. (I aim for 60-70 ng/ml.)

The IOM's definition of vitamin D adequacy rests on what level of 25-hydroxy vitamin D reverses hyperparathyroidism (high PTH levels) and rickets. Surely there is more to health than that.

Dr. Dowd and vocal vitamin D advocate, Dr. John Cannell, continue to champion the vitamin D cause that, like many health issues, conradicts the "wisdom" of official organizations like the IOM.

Comments (20) -

  • Anton

    12/19/2010 2:20:07 AM |

    Thanks for your great blog, and for your interest in Vitamin D.

    Along with doctors Dowd and Cannell, add Dr. Holick as another pioneer in Vitamin D. research.

  • Anonymous

    12/19/2010 4:58:25 AM |

    I bet natural vitamin d is far superior to oral supplementation.  I think vit D absorbtion is optimized by low carb, but you also need some sunlight added into the picture.

  • Dr. William Davis

    12/19/2010 1:59:13 PM |

    Hi, Anon--

    Where I live, it's been around 10 degrees Fahrenheit for about two weeks straight. Probably too cold to lay out in a bathing suit.

    For many of us, supplementation is the only choice.

    Also, don't forget that the majority of people after age 40 have lost much of their ability to activate vit D in the skin.

  • kellgy

    12/19/2010 5:02:25 PM |

    I just added his book to my wish list and it will be my next read. I am beginning to wonder why don't we seek to reach serum vitamin D somewhere between 100-150 range. Has there been any research indicating any response to these levels? Even with all the recent research focusing on vitamin D, it would be nice to understand overall health responses at varying degrees of serum content from deficiency to toxicity. We need a wider perspective to draw from.

    BTW, an update: 110 pounds and counting . . . My BMI is about to fall into the normal range and my health has never been better!

    This is an unusual thought. Sitting in front of a very warm and soothing fire last night, I was wondering how my skin reacts to the radiation, aside from the warmth and relaxation benefits.

  • IggyDalrymple

    12/20/2010 3:07:51 AM |

    My level dropped 20 points when I reduced my intake from 10,000 iu/day to 5,000 /day.  I went back to 10,000 and now I'm at 63 ng/ml.  I'll stick with 10,000 iu unless I exceed 100 ng/ml.

  • Susanne

    12/20/2010 7:06:08 AM |

    I wonder if there is not a missing piece to the puzzle of vitamin D deficiency in relation to adequate iodine levels.  I have appended text from the website Iodine4health.  In it Dr. Vickery noticed a connection between the two:

    ”I have also noted an apparent connection between bringing sufficient iodine to a bromine plugged thyroid, and the vitamin D metabolism of the body. Although I am unaware of the exact mechanism, it seems clear that the calcitonin/parathyroid hormone/Vitamin D/calcium balance in the body changes as people on iodine loading programs often register as vitamin D deficient when they did not previously."

    I believe this to be my case.  I tested my vitamin D levels for years and they were optimal based on Dr. Mercola's recommendations and I supplemented with D in the form of cod liver oil rarely.  Then I started taking iodine and I had such a dramatic improvement in symptoms that I knew I had been iodine deficient perhaps my entire life.  After 2-3 years of iodine supplemention I am going to get my D levels tested soon.

  • Anonymous

    12/20/2010 12:10:49 PM |

    Please write the name of the test you underwent to find iodine deficient?Is it a routine blood test that nay primary care doc can order?Readers please chime in please


  • Pater_Fortunatos

    12/20/2010 1:02:01 PM |

    Published less than a month ago:

    Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability

  • Anonymous

    12/20/2010 9:58:20 PM |

    "Probably too cold to lay out in a bathing suit."

    Did you try without?
    OK, couldn't resist.

  • Anonymous

    12/20/2010 10:21:05 PM |

    Just a quick question about D3 supplements. I know that dry tabs aren't ideal because they're hard for the body to absorb but what about capsulated powdered D3?

  • Anonymous

    12/21/2010 1:34:06 AM |

    Have an observation using a vitamin D light that I thought to mention.  I take vitamin D capsules and have been doing so for around 5 years.  This winter I decided that I would also use a vitamin D3 light pretty much each day in addition to taking the capsules.  I bought a light sold on Dr Cannell's sight.  I've noticed that sunlight and the artificial D3 light makes me feel warm through out the day, something D3 isn't able to do for me, at least.  And with this cold fall/winter going on right now, this 10 minutes of sunlight is a big plus!    

    Well, there might be a nice bonus from using the light.  I think I'm growing bigger, in a muscular way.  I do work out at a gym and have done so for over 1 years.  Just began the slow burn process last week.  But this muscle growth seems to have started around the time I made a conscious effort to use the indoor light or obtain some sunlight.  

    Anyway, no way to prove, and could be completely wrong about this.  Just something I've noticed as my shirts have grown tighter over the last couple months.  Weight has gone up also by a few pounds. I'm pleased.

  • Jessica

    12/22/2010 7:29:50 PM |

    SMK- the test for iodine that we order in our clinic (family practice) is an iodine loading 24 hour urine test.

    patients take 50 mg of iodoral then capture their urine for the next 24 hours to see how much is excreted.

    There is a 2 week prep, though, that helps ensure the test is accurate.

    Dr. Brownstein (?) has several books on the topic. I think he recommends the load testing method in his book, "Iodine, why we need it, why we can't live without it."

  • Chris Masterjohn

    12/23/2010 2:10:47 AM |

    I'll be posting my comments on the IOM report soon, although this sucker is 999 pages long and taking me a while to read.  I don't think it is at all true that it focuses on "deficiency" instead of "optimal levels."  I think it is quite clearly and very explicitly focused on optimal levels.  

    The IOM claims to not have found sufficient evidence to conclude that higher levels are optimal.  Now, I do believe that there is good enough evidence to act on the hypothesis that levels should be above 30 ng/mL, and my impression so far is that there is very little data supporting an argument for >50 ng/mL as some suggest.  That said, I won't be convinced that the IOM is *wrong* that definitive evidence for greater than 20 ng/mL is lacking until I finish reading the report and look at some of the primary references.

    I do think it's important, however, to exercise the freedom to act on hypotheses.  If we needed definitive evidence for everyone we do, our familial relations and whole lives would fall apart.  Still, I think the IOM had a responsibility to assess the quality of the evidence and only solidify what is definitive into recommendations, as long as those recommendations don't preclude the freedom to use higher levels.

    In any case, hopefully I can finish this bad boy in the next week and blog about it.


  • Anonymous

    12/24/2010 3:43:54 AM |

    Isn't anyone concerned about all those studies summarized in the IOM report showing increased mortality at the highest D levels? 50 ng/ml is the highest level that I can justify targeting.

  • Lacey

    12/24/2010 3:17:52 PM |

    Off topic, but...I wish Paleo bloggers were better at spotting and stopping spam comments.

    Blogger Brooklyn said...Awesome Blog!!! blah blah blah blah

    Funny, Brooklyn had the exact same words to say over on Stephan Guyanet's blog:

    His wonderful blog that he links back to says, among other things, "In the meantime, they recommend that all people, with or without diabetes, should have a healthy balanced diet, low in fat, salt and sugar with plenty of fruit and vegetables." It's also chock full of plagiarized text.

    Sincere paleo fan or linkspammer?  You be the judge.

  • Travis Culp

    12/25/2010 4:38:25 AM |

    Has anyone tested vitamin D levels in indigenous people? I try to dose about 30 minutes a day of sun during solar noon without a shirt on during the summer and 5000 IU a day for the rest of the year. No idea what my level would be though.

  • Peter

    12/25/2010 12:45:12 PM |

    I'm more concerned about official organizations going beyond the evidence (eat margarine! eat carbs! avoid saturated fat!) than  being over-cautious when there's not a lot of reliable research.

  • Anonymous

    1/4/2011 4:26:38 AM |

    One more comment on my apparently deleted comment - there's a possibiliy I never typed in the word verification code, but I believe I did actually post the comment. Sorry, if I did falsely accuse.

  • Brad Fallon

    3/5/2011 6:08:50 PM |

    Vitamin D Deficiency, what is the best natural source apart from sunshine to help keep the levels up?

  • Anonymous

    3/21/2011 4:15:01 PM |

    I just found my new vitamin store. The prices are the lowest I could find. They gave me a free gift of $5.00 with no minimum purchase and I got free shipping! The code I used at checkout is WIR500. Maybe it will work for you too?